NUR 231 LX: BREAST PALPATIONG DEMONSTRATION CRITERIA

1. NUR 231 LX: BREAST PALPATIONG DEMONSTRATION CRITERIA

2. INTRODUCTION • Welcome to the SKILL NUR 231: Breast Palpation Demonstration. • The material, for this skill, was not taken from your book, but from your handout, “Breast Palpation Demonstration Criteria.” • For this Power Point Presentation, I have divided it into 3 separate steps: • 1. NUR 231 LX: Handout of Breast Palpation Demonstration Criteria • Along with the above handout, there is a required video: NUV 1.04: Physical Examination: Breast and Axillae. • Ask your instructor where you would locate this video. • 2. Breast Awareness and Self-Exam – Taken directly from the American Cancer Society’s Website whose motto is “The Official Sponsor of Birthdays!” • 3. I will briefly discuss the following genes: BRCA1 and BRCA2. • The discussion of these genes is only for your knowledge and I highly doubt you will be tested on this, but I thought it was important that you are aware that certain individuals are carriers of these particular genes.

3. BREAST PALPATION DEMONSTRATION CRITERIA • Inspect breasts for symmetry-skin color-discharge-dimpling. • Correctly identifies / outlines area to be examined. • A. From below clavicle to infra-mammary ridge. • B. From Mid-Axillary line (tail of Spence) to sternum. • C. Axillae • Identifies three standard patterns to palpate entire breast area: • A. Circular • B. Vertical Strip • C. Wedge or Spokes of a wheel.

4. BREAST PALPATION DEMONSTRATION CRITERIA – CONT’D • Uses the flat palmar surface of the fingers (not the fingertips) to palpate. • Palpates in small circular motions with the three middle fingers together using sufficient pressure to compress breast tissue against chest wall. • Slides fingers from location to location; does not lift fingers off the breast. • Locates 5 lumps on model. • Describes the characteristics of each lump (i.e., number, size, shape, firmness). • States patient’s arm to be repositioned so it is relaxed at her side for palpation of the axilla.

5. BREAST PALPATON DEMONSTRATION CRITERIA – CONT’D • Uses small circular motions with the flat palmar surface of the fingers to palpate axillary lymph nodes from the apex of the axillary area down the: • A. Lateral chest wall. • B. Inner surface of the humerus. • C. Inner aspect of pectoralis muscle • D. Inner aspect of trapezius muscle.

6. BREAST AWARENESS AND SELF-EXAM AMERICAN CANCER SOCIETY • Beginning in their 20s, women should be told about the benefits and limitations of breast self-exam (BSE). Women should be aware of how their breasts normally look and feel and report any new breast changes to a health care professional as soon as they are found. • Finding a breast change does not necessarily mean there is cancer present. • A woman can notice changes by knowing how her breasts normally look and feel and feeling her breasts for changes (breast awareness), or by choosing to use a step-by-step approach (with a BSE) and using a specific schedule to examine her breasts. • BREAST IMPLANTS • Women with breast implants can do BSE. It may be useful to have the surgeon help identify the edges of the implant so that you know what you are feeling. • There is some thought that the implants push out the breast tissue and may make it easier to examine.

7. BREAST AWARENESS AND SELF-EXAM AMERICAN CANCER SOCIETY – CONT’D • If you choose to do BSE, the following information provides a step-by-step approach for the exam. • The best time for a woman to examine her breasts is when they are not tender or swollen. • Women who examine their breasts should have their technique reviewed during their periodic health exams by their health care professional. • It is acceptable for women to choose not to do BSE or to do BSE occasionally. • Women who are pregnant or breastfeeding can also choose to examine their breasts regularly. • Women who choose not to do BSE should still know how their breasts normally look and feel and report any changes to their doctor right away.

8. HOW TO EXAMINE YOUR BREASTS – taken from the American Cancer Society’s website • How to examine your breasts: • Lie down on your back and place your right arm behind your head. • The exam is done while lying down, not standing up. This is because when lying down the breast tissue spreads evenly over the chest wall and is as thin as possible, making it much easier to feel all the breast tissue. • Use the finger pads of the 3 middle fingers on your left hand to feel for lumps in the right breast. Use overlapping dime-sized circular motions of the finger pads to feel the breast tissue.

9. HOW TO EXAMINE YOUR BREASTS – taken from the American Cancer Society’s website • How to examine your breasts: (CONT’D) • Use 3 different levels of pressure to feel all the breast tissue. Light pressure is needed to feel the tissue closest to the skin; medium pressure to feel a little deeper; and firm pressure to feel the tissue closest to the chest and ribs. • It is normal to feel a firm ridge in the lower curve of each breast, but you should tell your doctor if you feel anything else out of the ordinary.

10. HOW TO EXAMINE YOUR BREASTS – taken from the American Cancer Society’s website • If you’re not sure how hard to press, talk with your doctor or nurse. Use each pressure level to feel the breast tissue before moving on to the next spot. • Move around the breast in and up and down pattern starting an imaginary line drawn straight down your side from the underarm and moving across the breast to the middle of the chest bone (sternum or breastbone). Be sure to check the entire breast area going down until you feel only ribs and up to the neck or collar bone (clavicle).

11. HOW TO EXAMINE YOUR BREASTS – taken from the American Cancer Society’s website • How to examine your breasts: (CONT’D) • There is some evidence to suggest that the up-and-down pattern (sometimes called the vertical pattern) is the most effective pattern for covering the entire breast without missing any breast tissue. • Repeat the exam on your left breast, putting your left arm behind your head and using the finger pads of your right hand to do the exam. • While standing in front of a mirror with your hands pressing firmly down on your hips, look at your breasts for any changes of size, shape, contour, or dimpling or redness or scaliness of the nipple or breast skin. (the pressing down on the hips position contracts the chest wall muscles and enhances any breast changes).

12. HOW TO EXAMINE YOUR BREASTS – taken from the American Cancer Society’s website • How to examine your breasts: (CONT’D) • Examine each underarm while sitting up or standing and with your arm only slightly raised so you can easily feel in this area. Raising your arm straight up tightens the tissue in this area and makes it harder to examine. • This procedure for doing breast self-exam is different from previous recommendations. These changes represent an extensive review of the medical literature and input from an expert advisory group. There is evidence that this position (lying down), the area felt, pattern of coverage of the breast, and use of different amounts of pressure increases a woman’s ability to find abnormal areas.

13. END OF SKILL • This is the end of the skill. • I have no access to your video for this, so you must ask your instructor how to obtain it. • The next few slides are just some information on the BRCA1 & BRCA2 Gene. • This is just for your information and this is not part of your skill, but I thought it was important that you had this information. • In order to pass this skill, you must practice it in the skills lab. • Good Luck!

14. BRCA1 AND BRCA2: CANCER RISK AND GENETIC TESTING • The information for this discussion was taken from the National Cancer Institute. • KEY POINTS: • A woman’s risk of developing breast and / or ovarian cancer is greatly increased if she inherits a deleterious (harmful) mutation in the BRCA1 gene or the BRCA2 gene. • Men with these mutations also have an increased risk of breast cancer, and both men and women who have harmful BRCA1 or BRCA2 mutations may be at increased risk of additional types of cancer. • Genetic tests can check for BRCA1 and BRCA2 mutations in people with a family history of cancer that suggests the possible presence of a harmful mutation in one of these genes.

15. BRCA1 AND BRCA2: CANCER RISK AND GENETIC TESTING • What are BRCA1 & BRCA2? • BRCA1 & BRCA2 are human genes that produce tumor suppressor proteins. These proteins help repair damaged DNA and, therefore, play a role in ensuring the stability of the cell’s genetic material. • When either of these genes is mutated, or altered, such that its protein product is not made or does not function correctly, DNA damage may not be repaired properly.

16. BRCA1 AND BRCA2: CANCER RISK AND GENETIC TESTING • As a result, cells are more likely to develop additional genetic altercations that can lead to cancer. • Specific inherited mutations in BRCA1 & BRCA2 increase the risk of female breast and ovarian cancers, and they have been associated with increased risks of several additional types of cancer. • Together, BRCA1 & BRCA2 mutations account for about 20 to 25 percent of hereditary breast cancer and about 5 to 10 percent of all breast cancers.

17. BRCA1 AND BRCA2: CANCER RISK AND GENETIC TESTING • In addition, mutations in BRCA1 & BRCA2 account for around 15 % of ovarian cancers overall. • Breast cancers associated with BRCA1 & BRCA2 mutations tend to develop at younger ages than sporadic breast cancers. • A harmful BRCA1 or BRCA2 mutation can be inherited from a person’s mother or father. Each child of a parent who carries a mutation in one of these genes has a 50% chance of inheriting. • However, in nearly half of families with multiple cases of breast cancer and in up to 90 percent of families with both breast and ovarian cancer, their disease is caused by harmful mutations in BRCA1 or BRCA2.